Her name was Sarah. Everything about her seemed perfectly organized--her long black braid falling ruler-straight between her shoulders, her folder with all of its documents sorted by date, her matching shoes and shirt, her entire wardrobe without a single wrinkle.

Her health was a bit less perfect. She'd been born with an atrial septal defect (ASD)--a hole in the wall separating the heart's right and left chambers. Tomorrow she was to have an operation to repair the hole, so she'd come in today, accompanied by her parents and brother, to sign the presurgical consent forms.

Vivian, the nurse, had given Sarah informational materials about her condition and the operation. With an air of poised self-possession, Sarah had read everything, asked appropriate questions and completed the consent form. She seemed quite prepared for tomorrow's procedure.

Meanwhile, I'd been standing silently in a corner. As a third-year medical student doing my surgery clerkship, I was here to observe the interview.

Up to this point, Sarah had directed her attention to Vivian. Now, as she peered at me over her glasses, awaiting my answer, I felt flustered--and keenly aware of the two inches of scar peeking out above the V-neck of my scrubs.

I hadn't expected to talk with her, much less to divulge my health history. Still, I thought, it's only fair to share it; she's accepted my being here while her own health was discussed.

"Yes, I did," I said. "I had surgery about two years ago to replace one of the valves in my heart."

Her eyes widened, and her features softened into a smile. All at once, she seemed much younger.

She studied the top of my scar (which is nearly an inch wide and runs down to my breastbone), and her expression turned to one of concern. I could guess what she was thinking.

"Don’t worry," I said. "Your incision won't be as long as mine."

Her parents chimed in.

"You're in medical school? How was your recovery? How do you feel now?"

Answering their questions, I relived my two-month recovery period. As I'd worked to regain my strength and make the transition to medical school, I'd experienced a wide range of emotions, from wallowing self-pity to blazing triumph. Some days, I wanted nothing more than to sleep and be alone; others, I would run for miles. My prevailing thought throughout those months, though, was the loss of my privacy.

Up to that point in my life, my illness had been invisible to others. I'd checked in with my pediatric cardiologist every six months, but otherwise I felt normal.

After the operation, there was no longer any hiding: Wherever I went, my body broadcast my health history. I didn't sign a release form permitting all of the stares I got at the beach or the pool; I didn't consent to the uninvited queries, the pointing, the whispers--but nonetheless, they became a part of my life.

Talking with Sarah's parents, I remembered, too, how stressful my own parents had found my surgery.

As anxious as her parents feel, I reflected, it must be comforting for them to see that she can look forward to a normal future.

In that moment, I became aware of what a strong bond Sarah's question had forged between us. Having endured the countless echocardiograms, exercise stress tests, Holter monitors and EKGs that congenital heart disease (CHD) demands, we two shared a common experience and knowledge that no one else in the room could fully understand.

Soon, I reflected, she too will bear a physical reminder of her journey with CHD.

Throughout the rest of the visit, Sarah looked to me, literally, to confirm the information Vivian was giving her. It was as though my personal experience meant more to her than any medical data, however reliable.

When Vivian said, "The day after your procedure, you'll be able to stand up and walk around," Sarah glanced at me, and I nodded.

After several more of these silent consultations, Vivian actively involved me in the conversation.

"After you go home, you'll be able to do everything you normally would, but it will take time to regain your stamina," she said. "Joe, would you agree?"

"I agree completely. If you commit to your rehabilitation, you'll feel better than ever after only a few weeks," I answered, marveling at how my experiences of patienthood and vulnerability were empowering me to play an active role as Sarah’s caregiver.

The visit drew to a close, and the family prepared to go; we all shook hands. Sarah was the last to leave. Reaching up, she put her arms around my neck and hugged me.

"Thank you so much for being here today," she whispered.

I feel grateful to have had the chance to share my story with Sarah. Our encounter reminded me that it's not only pharmacology and procedures that make a difference in medicine; it's also the relationships we forge during our struggles, and the bonds we share with those who are traveling similar roads.

I realize that my scar will always be a part of my identity as a physician and healer. It's a doorway to openness with my colleagues and patients. I can never aspire to the image of the all-powerful, invulnerable physician. My scar is my humanity. There's no escaping it; the evidence is etched upon my body.

About the author:

Joseph Burns is a medical student at the Herbert Wertheim College of Medicine at Florida International University, in Miami. A native of Orlando, he is passionate about the arts and community engagement. His interests include congenital heart disease and American Indian health, and he hopes to pursue a career in adult congenital cardiology. His writing has appeared in Reflective MedEd. "During my recovery from heart surgery in the summer of 2015, I realized the importance of reflection in my healing. Though there have been times in which I have felt embarrassed about my scar, more often than not it's a badge of honor, of survival. It's an open door for advocacy and for connection with those who have endured similar battles."

Comments

Joe, thank you sharing this story. I read it last weekend, but only now have had the chance to respond. My eldest son carries a scar like yours. Born with a complex congenital heart defect, he has had four heart surgeries -four by the time he hit 19. His last one was between his freshman and sophomore years. Like you, he encounters stares at the pool. For a while, he always wore a shirt to cover his scars (oldest to newest). Though he never said that was his reason. Now, he simply explains it to people who ask. He's had fantastic care by incredible clinicians but to have had someone like you by his bedside would have meant something else. You are correct in your observation that living with CHD is an experience that has nuance few truly know: so much lies beneath those scars. Thank you for your story. I will send it to my son (now a junior) and who like you is pursuing a medical career. I wish you well and hope you continue to write.

Very nicely written story - and touching - story. I, too, loved the "release form" for the beach.

Speaking as a surgeon of ~35 years experience, our patient's bodies rely on our expertise, but THEY rely on our humanity. While I would never have wished your surgery on you, you'll certainly find that it will continue to help you bond with your patients. The "all-powerful, invulnerable physician" is a dangerously misguided image, our patients just want someone who exhibits understanding of and commitment to them.

My diagnosis of myeloma 7 years ago followed by a stem cell transplant and, now, weekly chemo has had that silver lining. I'd rather not have it, but it certainly has enabled me to reassure patients facing chemo or with new cancer diagnoses that life can and will go on!

So, how has it gone for you and Sarah? Can you share any f/u with us?

Congratulations on both the nice piece of writing and the nice piece of doctoring! Tyr Wilbanks

Added to everything else, I love your sentence "I didn't sign a release form permitting all of the stares I got at the beach or the pool;" - combining in a biting way the bureaucratic aspect of medicine with the emotional.

"My scar is my humanity." Indeed, it is, future doctor Joe Burns. YOU are one more reason to be hopeful about the future of medicine. Scars are indeed "doorways to openness" and healing.

I was reminded of something Beck Weathers, MD said about scars that has stayed with me for over 20 years. I'm including the link to a 6-min (amateur) video from a talk he delivered at a CME conference in 1997...one year after he survived the Mt Everest tragedy (written about in Jon Krakauer's book, Into Thin Air). Beginning at the 3:10 mark, he reflects: "I want to look in that mirror everyday...and I want to see that...and be reminded of it..."

Well done. We are indeed humans and our interactions are with real people. Reminds me of the time a medical student who had gone through her own problems with glomerulonephritis and kidney disease as a child intervened as a nephrologist painted a very bleak picture to the family of a child with the same condition. She didn’t agree. Your experiences can only augment the care you provide as a physician.

One of the sorrows of modern medicine is the loss of Humanism... the fact that we, as physicians, are human and that we SHOULD share ourselves. Medical practice is not impersonal. Obviously, there remains an appropriate limit. I don't often share my history of 40 years ago overcoming cocaine use but sometimes I do... At times, a physician can accomplish more healing with a hug than any scalpel can produce. ...and it needn't be an actual physical hug... a kind word of empathy will do nicely.

Reading this I am reminded of the sermon the week after Easter when the gospel reading was about 'doubting" Thomas. Despite common pejorative categorizations of Thomas, most of us feel an affinity for this character. Thomas didn't ask to just see and touch Jesus; he said he had to see and touch his SCARS. The point the preacher made was that the message of good news was that the resurrected Jesus RETAINED his scars. Scars on the divine body are not something that need to be ‘fixed’ but powerful connectors to all of us who are scarred in a wide variety of ways.

This is a powerful, compassionate, and inspiring essay. Thank you Joseph Burns for sharing it and for bringing your vulnerability/strength to your work as a healer. We need more people like you in our healthcare systems!